MEDICARE: DANIEL BRODIE MCINTOSH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	M5406	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010005765	OTHER	ID	REGENCE
2	54064	OTHER	ID	BLUE CROSS OF IDAHO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801831151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL BRODIE MCINTOSH MD

Provider Business Mailing Address
First Line	:	307 SAINT JOHNS WAY
Second Line	:	STE #9
City	:	LEWISTON
State	:	ID
Zip	:	83501-2435
Country	:	US
Telephone Number	:	208-746-7055
Fax Number	:	208-746-4899

Provider Business Practice Location Address
First Line	:	307 SAINT JOHNS WAY
Second Line	:	STE #9
City	:	LEWISTON
State	:	ID
Zip	:	83501-2435
Country	:	US
Telephone Number	:	208-746-7055
Fax Number	:	208-746-4899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/08/2007

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